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Meta-Analysis
. 2010 Jun 16;2010(6):CD005211.
doi: 10.1002/14651858.CD005211.pub2.

Exercise interventions for upper-limb dysfunction due to breast cancer treatment

Margaret L McNeely  1 , Kristin Campbell, Maria Ospina, Brian H Rowe, Kelly Dabbs, Terry P Klassen, John Mackey, Kerry Courneya
Affiliations
Meta-Analysis

Exercise interventions for upper-limb dysfunction due to breast cancer treatment

Margaret L McNeely et al. Cochrane Database Syst Rev. .

Abstract

Background: Upper-limb dysfunction is a commonly reported side effect of treatment for breast cancer and may include decreased shoulder range of motion (the range through which a joint can be moved) (ROM) and strength, pain and lymphedema.

Objectives: To review randomized controlled trials (RCTs) evaluating the effectiveness of exercise interventions in preventing, minimi sing, or improving upper-limb dysfunction due to breast cancer treatment.

Search strategy: We searched the Specialised Register of the Cochrane Breast Cancer Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008); contacted experts, handsearched reference lists, conference proceedings, clinical practice guidelines and other unpublished literature sources.

Selection criteria: RCTs evaluating the effectiveness and safety of exercise for upper-limb dysfunction.

Data collection and analysis: Two authors independently performed the data abstraction. Investigators were contacted for missing data.

Main results: We included 24 studies involving 2132 participants. Ten of the 24 were considered of adequate methodological quality.Ten studies examined the effect of early versus delayed implementation of post-operative exercise. Implementing early exercise was more effective than delayed exercise in the short term recovery of shoulder flexion ROM (Weighted Mean Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI): 4.51 to 16.6); however, early exercise also resulted in a statistically significant increase in wound drainage volume (Standardized Mean Difference (SMD) 0.31; 95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI: 0.65 to 1.65).Fourteen studies examined the effect of structured exercise compared to usual care/comparison. Of these, six were post-operative, three during adjuvant treatment and five following cancer treatment. Structured exercise programs in the post-operative period significantly improved shoulder flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI: 0.69 to 25.16). Physical therapy treatment yielded additional benefit for shoulder function post-intervention (SMD: 0.77; 95% CI: 0.33 to 1.21) and at six-month follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There was no evidence of increased risk of lymphedema from exercise at any time point.

Authors' conclusions: Exercise can result in a significant and clinically meaningful improvement in shoulder ROM in women with breast cancer. In the post-operative period, consideration should be given to early implementation of exercises, although this approach may need to be carefully weighed against the potential for increases in wound drainage volume and duration. High quality research studies that closely monitor exercise prescription factors (e.g. intensity), and address persistent upper-limb dysfunction are needed.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts, financial or otherwise. Drs Courneya and Mackey were investigators of one of the included studies.

Figures

1
1
Forest plot of comparison: 1 Post‐operative: Early versus Delayed Exercise, outcome: 1.3 Shoulder Flexion ROM in degrees.
2
2
Forest plot of comparison: 1 Post‐operative: Early versus Delayed Exercise, outcome: 1.6 Incidence of Seroma.
3
3
Forest plot of comparison: 1 Post‐operative: Early versus Delayed Exercise, outcome: 1.7 Wound Drainage Volume in ml.
4
4
Forest plot of comparison: 1 Post‐operative: Early versus Delayed Exercise, outcome: 1.8 Wound Drainage Volume in ml: Studies 1995 and later.
5
5
Forest plot of comparison: 1 Post‐operative: Early versus Delayed Exercise, outcome: 1.9 Duration of Drainage in days.
6
6
Forest plot of comparison: 2 Post‐operative: Exercise versus Comparison/ control, outcome: 2.1 Shoulder Flexion.
7
7
Forest plot of comparison: 2 Post‐operative: Exercise versus Comparison/ control, outcome: 2.2 Shoulder Flexion: Physical Therapy subgroup.
8
8
Forest plot of comparison: 2 Post‐operative: Exercise versus Comparison/ control, outcome: 2.5 Shoulder Function.
1.1
1.1. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 1 Impaired Shoulder Mobility.
1.2
1.2. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 2 Degrees Limitation in Shoulder Flexion ROM.
1.3
1.3. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 3 Shoulder Flexion ROM in degrees.
1.4
1.4. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 4 Degrees Limitation in Shoulder Abduction ROM.
1.5
1.5. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 5 Shoulder Abduction ROM in degrees.
1.6
1.6. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 6 Incidence of Seroma.
1.7
1.7. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 7 Wound Drainage Volume.
1.8
1.8. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 8 Wound Drainage Volume: Studies 1995 and later.
1.9
1.9. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 9 Duration of Drainage in days.
1.10
1.10. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 10 Mean number of Aspirations.
1.11
1.11. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 11 Delayed Wound Healing.
1.12
1.12. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 12 Pain.
1.13
1.13. Analysis
Comparison 1 Post‐operative: Early versus Delayed Exercise, Outcome 13 Incidence of Lymphedema.
2.1
2.1. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 1 Shoulder Flexion ROM in degrees.
2.2
2.2. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 2 Shoulder Flexion: Physical Therapy subgroup.
2.3
2.3. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 3 Shoulder Abduction ROM in degrees.
2.4
2.4. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 4 Incidence of Seroma.
2.5
2.5. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 5 Shoulder Function.
2.6
2.6. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 6 Shoulder Abduction: Physical Therapy subgroup.
2.7
2.7. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 7 Wound Drainage Volume.
2.8
2.8. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 8 Pain.
2.9
2.9. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 9 Incidence of Lymphedema.
2.10
2.10. Analysis
Comparison 2 Post‐operative: Exercise versus Comparison/ control, Outcome 10 Arm Volume in mL.
3.1
3.1. Analysis
Comparison 3 During Adjuvant Treatment: Exercise versus Comparison/ control, Outcome 1 Shoulder Flexion ROM Post Intervention.
3.2
3.2. Analysis
Comparison 3 During Adjuvant Treatment: Exercise versus Comparison/ control, Outcome 2 Shoulder Abduction ROM Post Intervention.
3.3
3.3. Analysis
Comparison 3 During Adjuvant Treatment: Exercise versus Comparison/ control, Outcome 3 Upper‐Extremity Strength Post Intervention.
3.4
3.4. Analysis
Comparison 3 During Adjuvant Treatment: Exercise versus Comparison/ control, Outcome 4 Pain VAS.
3.5
3.5. Analysis
Comparison 3 During Adjuvant Treatment: Exercise versus Comparison/ control, Outcome 5 Quality of Life Post Intervention.
3.6
3.6. Analysis
Comparison 3 During Adjuvant Treatment: Exercise versus Comparison/ control, Outcome 6 Incidence of Lymphedema.
4.1
4.1. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 1 Incidence of Shoulder Movement Restriction.
4.2
4.2. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 2 Shoulder ROM: Sum of Directions Post Intervention.
4.3
4.3. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 3 Shoulder Flexion ROM Post Intervention.
4.4
4.4. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 4 Shoulder Abduction ROM Post Intervention.
4.5
4.5. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 5 Upper‐Extremity Strength.
4.6
4.6. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 6 Incidence of Upper‐Extremity Strength Impairment.
4.7
4.7. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 7 Quality of Life Post Intervention.
4.8
4.8. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 8 Incidence of Lymphedema.
4.9
4.9. Analysis
Comparison 4 Post Cancer Treatment: Exercise versus Comparison/ control, Outcome 9 Arm Circumference.
See this image and copyright information in PMC

Comment in

References

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